Institute of Medical Epidemiology, Biostatistics, and Informatics, Faculty of Medicine, University of Halle-Wittenberg, Halle (Saale), Germany.
J Thorac Cardiovasc Surg. 2010 Oct;140(4):829-35, 835.e1-13. doi: 10.1016/j.jtcvs.2009.12.022. Epub 2010 Feb 18.
Despite numerous randomized and nonrandomized trials on off- and on-pump coronary artery bypass grafting, it remains open which method is superior. Patient selection and small sample sizes limit the evidence from randomized trials; lack of randomization limits the evidence from nonrandomized trials. Propensity score analyses are expected to improve on at least some of these problems. We aimed to systematically review all propensity score analyses comparing off- and on-pump coronary artery bypass grafting.
Propensity score analyses comparing off- and on-pump surgery were identified from 8 bibliographic databases, citation tracking, and a free web search. Two independent reviewers abstracted data on 11 binary short-term outcomes.
A total of 35 of 58 initially retrieved propensity score analyses were included, accounting for a total of 123,137 patients. The estimated overall odds ratio was less than 1 for all outcomes, favoring off-pump surgery. This benefit was statistically significant for mortality (odds ratio, 0.69; 95% confidence interval, 0.60-0.75), stroke, renal failure, red blood cell transfusion (P < .0001), wound infection (P < .001), prolonged ventilation (P < .01), inotropic support (P = .02), and intraaortic balloon pump support (P = .05). The odds ratios for myocardial infarction, atrial fibrillation, and reoperation for bleeding were not significant.
Our systematic review and meta-analysis of propensity score analyses finds off-pump surgery superior to on-pump surgery in all of the assessed short-term outcomes. This advantage was statistically significant and clinically relevant for most outcomes, especially for mortality, the most valid criterion. These results agree with previous systematic reviews of randomized and nonrandomized trials.
尽管有许多关于体外循环和非体外循环冠状动脉旁路移植术的随机和非随机试验，但哪种方法更优仍存在争议。随机试验的证据受到患者选择和样本量小的限制；非随机试验的证据受到缺乏随机化的限制。倾向评分分析有望至少改善其中一些问题。我们旨在系统地回顾所有比较体外循环和非体外循环冠状动脉旁路移植术的倾向评分分析。
从 8 个文献数据库、引文追踪和免费网络搜索中确定了比较体外循环和非体外循环手术的倾向评分分析。两名独立的审查员提取了 11 项短期二元结局的数据。
共纳入了最初检索到的 58 项倾向评分分析中的 35 项，共纳入了 123137 名患者。所有结局的总体优势比均小于 1，支持非体外循环手术。这种益处在死亡率（优势比，0.69；95%置信区间，0.60-0.75）、中风、肾衰竭、红细胞输血（P <.0001）、伤口感染（P <.001）、延长通气（P <.01）、正性肌力支持（P =.02）和主动脉内球囊泵支持（P =.05）方面具有统计学意义。心肌梗死、心房颤动和因出血再次手术的优势比没有统计学意义。
我们对倾向评分分析的系统回顾和荟萃分析发现，非体外循环手术在所有评估的短期结局中均优于体外循环手术。这种优势在统计学上是显著的，在临床上也是相关的，尤其是对死亡率这一最有效的标准。这些结果与以前关于随机和非随机试验的系统综述一致。
